MEDICARE: CEDAR FOREST THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1780462036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR FOREST THERAPY, LLC

Provider Business Mailing Address
First Line	:	2210 BARTON AVE APT 2
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-4442
Country	:	US
Telephone Number	:	605-661-8766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 BARTON AVE APT 2
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-4442
Country	:	US
Telephone Number	:	605-661-8766
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAERON-RAE DUKES
Credential	:
Telephone Number	:	605-661-8766

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	12/12/2025

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